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BUILDING PERMIT APPLICATION <br /> Applicant To Complete This Form <br /> If more than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A separate permit will be issued for each build- <br /> ing. <br /> uilding. o <br /> Owner I Building Address �'- <br /> Addr _ /..? Lot/_ Blk._ Sec. <br /> Cit Phone Twp•,2z Rge• -5 <br /> Architect Subdivision (Plat)ar,-9 ULSr ✓/7. <br /> City Phone Metes & Bounds (Unplatted) , OT /s' <br /> Contractor ,! ) ( /l"�r. -� GJ 3s�rr. VTIb <br /> Address / <br /> City Phone Building Use4941:trr�-��,,.,�� <br /> State License Number' Describe Work to Be DonE-9► pLtCI` 7"'A <br /> Expiration Date <br /> TUse of Building PICIMj4K ! Y_ New VAddition Repair/Remodel <br /> 00 <br /> ---- Valuation of Construction $ 320 <br /> PLOT PLAN — <br /> Indicate lot size, name of streets, <br /> G / indicate location and width of <br /> alleys, locate proposed and all <br /> existing buildings, show distances <br /> to property lines, show distances <br /> between buildings. <br /> Lot size x <br /> Lot area S.F. <br /> - Size of Bldg S.F. I <br /> Number of Stor es <br /> Baseme <br /> Use Zo <br /> --, 8i d B ! <br /> TT7l� 1 <br /> For ! <br /> ,�•�. l^�•� / G:'� Owner <br /> DO N '1 DELOI IliS 'I E- OR hTY-USE ONLY <br /> Date Received -YC Fire Zone <br /> Plan Check Number f Typo of Construction <br /> ValuationL'�, QS" Occupancy Group <br /> Permit Fee S Occupant Load <br /> Plan Check Fee Sprinklers Required <br /> i <br /> Total Foo Due �. <br /> i <br /> Permit Number <br /> Date Issued <br /> APPROVED FOR DUILDING PERMIT <br /> Date_ <br />